Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series
<b>Background/Objectives</b>: The main objective of the study is to assess the clinical utility of microbial cell-free DNA (mcfDNA) in neutropenic patients diagnosed with acute myeloid leukemia (AML) undergoing chemotherapy in the outpatient setting. Neutropenia is a common complication...
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2025-07-01
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| author | Maria Lampou Elizabeth C. Trull Hailey M. Warren Musie S. Ghebremichael Raja Nakka Daniel J. Floyd Amir T. Fathi Andrew M. Brunner Michael K. Mansour |
| author_facet | Maria Lampou Elizabeth C. Trull Hailey M. Warren Musie S. Ghebremichael Raja Nakka Daniel J. Floyd Amir T. Fathi Andrew M. Brunner Michael K. Mansour |
| author_sort | Maria Lampou |
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| description | <b>Background/Objectives</b>: The main objective of the study is to assess the clinical utility of microbial cell-free DNA (mcfDNA) in neutropenic patients diagnosed with acute myeloid leukemia (AML) undergoing chemotherapy in the outpatient setting. Neutropenia is a common complication in this patient cohort and enhances the risk of fatal opportunistic bacterial and fungal infections. Accurate and timely diagnosis of these infections in outpatient asymptomatic individuals is critical. <b>Methods</b>: Fourteen patients were studied in this prospective observational case series. Traditional blood cultures (BCs) were obtained when clinically indicated and blood samples were collected for plasma mcfDNA metagenomic sequencing up to two times a week at outpatient oncology appointments. Results were compared in identifying potential infectious agents. <b>Results</b>: BCs identified pathogens in only two patients, despite several cases where infection was suspected. In contrast, mcfDNA testing detected pathogens in 11 of the 14 patients, including bacteria, such as <i>Staphylococcus aureus</i>, and invasive fungi, such as <i>Candida</i> and <i>Aspergillus</i> species, and <i>Pneumocystis jirovecii</i>. <b>Conclusions</b>: In the outpatient setting, mcfDNA surveillance offers a more reliable method for detecting pathogens. This approach identified actionable microbiologic results in immunocompromised individuals who did not meet standard clinical criteria for suspicion of infection. Further research is required to confirm the potential of mcfDNA surveillance in an outpatient setting to guide more accurate treatment decisions, reduce extensive clinical investigations, and improve neutropenic patient outcomes. |
| format | Article |
| id | doaj-art-e02dc3968b7f4616aeea6d9870e9e9ee |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Diagnostics |
| spelling | doaj-art-e02dc3968b7f4616aeea6d9870e9e9ee2025-08-20T03:50:17ZengMDPI AGDiagnostics2075-44182025-07-011513171510.3390/diagnostics15131715Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case SeriesMaria Lampou0Elizabeth C. Trull1Hailey M. Warren2Musie S. Ghebremichael3Raja Nakka4Daniel J. Floyd5Amir T. Fathi6Andrew M. Brunner7Michael K. Mansour8Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USADivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USADivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USADepartment of Medicine, Harvard Medical School, Boston, MA 02115, USARagon Institute of Mass General Brigham, Massachusetts Institute of Technology and Harvard, Cambridge, MA 02139, USADivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USADepartment of Medicine, Harvard Medical School, Boston, MA 02115, USADepartment of Medicine, Harvard Medical School, Boston, MA 02115, USADivision of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA<b>Background/Objectives</b>: The main objective of the study is to assess the clinical utility of microbial cell-free DNA (mcfDNA) in neutropenic patients diagnosed with acute myeloid leukemia (AML) undergoing chemotherapy in the outpatient setting. Neutropenia is a common complication in this patient cohort and enhances the risk of fatal opportunistic bacterial and fungal infections. Accurate and timely diagnosis of these infections in outpatient asymptomatic individuals is critical. <b>Methods</b>: Fourteen patients were studied in this prospective observational case series. Traditional blood cultures (BCs) were obtained when clinically indicated and blood samples were collected for plasma mcfDNA metagenomic sequencing up to two times a week at outpatient oncology appointments. Results were compared in identifying potential infectious agents. <b>Results</b>: BCs identified pathogens in only two patients, despite several cases where infection was suspected. In contrast, mcfDNA testing detected pathogens in 11 of the 14 patients, including bacteria, such as <i>Staphylococcus aureus</i>, and invasive fungi, such as <i>Candida</i> and <i>Aspergillus</i> species, and <i>Pneumocystis jirovecii</i>. <b>Conclusions</b>: In the outpatient setting, mcfDNA surveillance offers a more reliable method for detecting pathogens. This approach identified actionable microbiologic results in immunocompromised individuals who did not meet standard clinical criteria for suspicion of infection. Further research is required to confirm the potential of mcfDNA surveillance in an outpatient setting to guide more accurate treatment decisions, reduce extensive clinical investigations, and improve neutropenic patient outcomes.https://www.mdpi.com/2075-4418/15/13/1715microbial cell-free DNAinfectionshematologic malignanciesacute myeloid leukemianeutropeniaimmunocompromised |
| spellingShingle | Maria Lampou Elizabeth C. Trull Hailey M. Warren Musie S. Ghebremichael Raja Nakka Daniel J. Floyd Amir T. Fathi Andrew M. Brunner Michael K. Mansour Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series Diagnostics microbial cell-free DNA infections hematologic malignancies acute myeloid leukemia neutropenia immunocompromised |
| title | Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series |
| title_full | Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series |
| title_fullStr | Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series |
| title_full_unstemmed | Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series |
| title_short | Clinical Utility of Plasma Microbial Cell-Free DNA Surveillance in Neutropenic Patients with Acute Myeloid Leukemia Undergoing Outpatient Chemotherapy: A Case Series |
| title_sort | clinical utility of plasma microbial cell free dna surveillance in neutropenic patients with acute myeloid leukemia undergoing outpatient chemotherapy a case series |
| topic | microbial cell-free DNA infections hematologic malignancies acute myeloid leukemia neutropenia immunocompromised |
| url | https://www.mdpi.com/2075-4418/15/13/1715 |
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